Introduction/Purpose Lymphatic malformations are low-flow congenital lesions that frequently occur in the head and neck and often require treatment to address airway compromise, infection risk, bleeding, or cosmesis. Multiple treatment approaches have been employed, including resection, percutaneous sclerotherapy, laser photocoagulation, or a combination of these methods. Numerous agents have been utilised for percutaneous sclerotherapy. Ethanolamine oleate has approval from the Food and Drug Administration (FDA) for sclerosis of varices, yet little has been published on use of this agent for facial venous malformations. This study reports single centre results of percutaneous sclerotherapy with ethanolamine to treat lymphatic malformations of the head and neck.
Materials and Methods Prospectively maintained procedural records were retrospectively reviewed to identify all patients with lymphatic malformations who underwent percutaneous sclerotherapy The Mulliken and Glowacki classification was used to diagnose lymphatic malformations. Medical records and images were reviewed to record demographic information, lesion characteristics, treatment sessions, and clinical and imaging response. Lesions were categorised as not visible, small, medium, or large, and clinical response was categorised as excellent, good, fair, or poor in keeping with previously reported classification schemes. Lack of residual visible lesion was considered an excellent response. Good response was assigned when visible post-treatment size was subjectively less than half the pre-treatment size. Fair was assigned when residual size was great than half that prior to treatment. Poor response was assigned for no reduction or lesion enlargement. Quantitative volumetric analysis was conducted according to methods we have presented elsewhere. Response was assessed after each session and after all sessions in those patients undergoing more than one intervention. Chi-square analysis was performed to evaluate effects of above-described characteristics on outcomes.
Results 12 interventions were performed for lesions in 9 patients. No procedural complications occurred following any procedures. Four (44.4%) patients had an excellent result after treatment, which was accomplished in one session for each of these lesions. Three (33.3%) had good results, with one lesion being treated twice. One (11.1%) had a fair result after three sessions. One (11.1%) patient with an indeterminate syndrome with multiple congenital anomalies had a poor response following treatment. The family decided to withdraw care, and the airway was compromised. Average lesion volume reduction was 28% for all lesions and 42% when excluding the lesion for which future treatments were declined. Purely macrocystic lesions were more likely to have excellent response to treatment than lesions with both macrocystic and microcystic components χ2 (3, n=12) = 12.0, p=0.007.
Conclusion Many approaches have been utilised to treat lymphatic malformations of the head and neck. Practitioners performing percutaneous sclerotherapy have many options when choosing an agent. This study demonstrates the safety and efficacy of ethanolamine oleate for this use. Percutaneous sclerotherapy with ethanolamine should be considered when treating these complex lesions, particularly those that are exclusively macrocystic. Further investigation of such treatments should evaluate ethanolamine alongside the many others currently utilised.
Disclosures M. Alexander: None. R. McTaggart: None. O. Choudhri: None. M. Marcellus: None. H. Do: None.
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